|
|
 |
|
CLINICAL IMAGE |
|
Year : 2022 | Volume
: 19
| Issue : 1 | Page : 62-63 |
|
Transverse vaginal septum causing hematometrocolpos
Priya Singh, Surya Pratap Singh, Vaibhav Gupta
Department of Radiodiagnosis, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
Date of Submission | 10-Aug-2021 |
Date of Decision | 08-Sep-2021 |
Date of Acceptance | 10-Sep-2021 |
Date of Web Publication | 26-Oct-2021 |
Correspondence Address: Priya Singh Department of Radiodiagnosis, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Raebareli Road, Lucknow - 226 014, Uttar Pradesh India
 Source of Support: None, Conflict of Interest: None
DOI: 10.4103/am.am_95_21
How to cite this article: Singh P, Singh SP, Gupta V. Transverse vaginal septum causing hematometrocolpos. Apollo Med 2022;19:62-3 |
A 20-year-old female presented with primary amenorrhea and cyclical lower abdominal pain. Clinical and pelvic examination was completely normal with the presence of normal secondary sexual characteristics. Ultrasonography of the pelvis revealed echogenic fluid collection in the proximal vagina, cervix, and uterus with a normal appearance of bilateral ovaries. These findings were suggestive of hydro or hematometrocolpos. Moreover, the possibility of imperforate hymen, transverse vaginal septum, lower vaginal atresia, and hemi-vaginal atresia was kept. For further evaluation, a magnetic resonance imaging (MRI) of the pelvis was ordered. MRI [Figure 1] and [Figure 2] revealed upper vagina, cervix, and lower uterus were markedly distended with T1 isointense and T2 hyperintense cystic content representing hematometrocolpos. A 2-mm thick hypointense septum or membrane was seen in the upper one-third vagina, leading to obstruction and proximal collection of blood. Lower one-third of the vagina was collapsed. Bilateral ovaries were normal. No other genito-urinary abnormality was present. Thus, a diagnosis of transverse vaginal septum causing hematometrocolpos was made. Septum was although thin but approximately 4 cm from introitus; therefore, an abdomen-perineal approach using laparotomy was used for complete surgical resection of the septum.[1] Laparoscopic resection is a recent method for resection of such type of transverse vaginal septum, but requires expertise.[1] | Figure 1: Magnetic resonance imaging. (a) T2-weighted sagittal image, (b) T1-weighted coronal image, (c) T2-weighted fat saturated coronal image shows marked distention of upper vagina, cervix, and lower uterus with T1 isointense and T2 hyperintense cystic content representing hematometrocolpos (blue arrow). A thick hypointense septum or membrane (white arrow) is present in the upper one-third vagina, leading to obstruction. Note normal and collapsed distal two-third of the vagina (yellow arrow)
Click here to view |
 | Figure 2: Magnetic resonance imaging. T2-weighted fat saturated axial images shows (a) normal distal vagina (yellow arrow) and (b) proximal vagina distended with hemorrhagic contents showing T2 shading (blue arrow)
Click here to view |
A transverse vaginal septum is a rare congenital uterovaginal anomaly with a reported prevalence of 1 in 30,000 to 1 in 84,000 females.[2] The transverse vaginal septum has been described in the upper third in 46% of patients, middle third in 40% of patients, and lower third 14% in patients.[3] The thickness of the septum can be variable, with a thicker septum usually located toward the cervix. They can be associated with other urogenital anomalies. It needs to be differentiated from imperforate hymen, which is generally in the lower third of the vagina, thin, and transilluminate on vaginal examination. Early recognition of this obstructive vaginal lesion is essential to preserve fertility and prevent complications from retrograde tubal reflux and subsequent endometriosis.
Declaration of patient consent
The authors certify that they have obtained all appropriate patient consent forms. In the form the patient (s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initial s will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
References | |  |
1. | Jain N, Gupta A, Kumar R, Minj A. Complete imperforate tranverse vaginal septum with septate uterus: A rare anomaly. J Hum Reprod Sci 2013;6:74-6.  [ PUBMED] [Full text] |
2. | Deligeoroglou E, Makrakis E, Creatsas G. Obstruction of the female genital tract because of vaginal septum in adolescence. J Gynecol Surg 2001;17:49-56. |
3. | Deligeoroglou E, Iavazzo C, Sofoudis C, Kalampokas T, Creatsas G. Management of hematocolpos in adolescents with transverse vaginal septum. Arch Gynecol Obstet 2012;285:1083-7. |
[Figure 1], [Figure 2]
|